How to save money on biologics and biosimilar medications
Most oral medications work in a scattershot approach. When you take an ibuprofen, for instance, those chemicals circulate through your entire system, blocking any inflammation (and pain) they find. So even if you’re just popping an Advil® for a headache, it impacts the rest of your body, too.
For some conditions, traditional medications such as these work best, says Karen Kier, PhD. She’s a professor of clinical pharmacy at Ohio Northern University in Ada. These medications are the go-to for an infection or if you’re managing chronic pain. But for others, a targeted approach can work even better.
Enter: biologics. This group of medications acts differently in the body. “Biologics can be manufactured to be very specific for a certain cell, tissue or receptor in the body,” says Kier. This means they can better target the source of a disease or even halt it completely.
Biologics are most often used to treat autoimmune conditions such as rheumatoid arthritis (RA), psoriasis, multiple sclerosis and Crohn’s disease. But they’re also used for a variety of other diseases, including diabetes, chronic kidney disease and asthma. Brand-name biologics you may have heard of include Humira, an immunosuppressant, and Lantus, a long-acting insulin.
Another growing field for biologics is cancer treatment. Cancer cells have a way of hiding from our immune systems. “But biologics can help the body recognize cancer cells and kill them,” says Kier. Not only does this help prevent the growth and spread of cancer, but it can also spare healthy tissues.
Biologics have been a major boon for medicine, making it possible to treat some previously untreatable diseases. The downside? They’re very expensive. People using these medications to treat chronic conditions might pay an average of $10,000 to $30,000 a year, according to a paper in the journal Drugs. The cost for the most expensive biologic treatments could rise to more than $500,000 a year.
Let’s dive into why that is — and what you can do about it. (Your first stop? Download our free prescription discount app. Simply search for your medication for coupons of up to 80% off.)
Why are biologics so expensive?
The main reason is that they’re difficult to make. According to the U.S. Food and Drug Administration (FDA), most traditional medications are made by mixing together chemical ingredients. Biologics, however, are made with living organisms. Examples include yeast, bacteria or cells from animals or humans. And these materials can be more sensitive and unwieldy to work with than chemicals in a “recipe.”
“The costs to research, develop and ultimately manufacture these products on a commercial scale are much higher,” says Christine Simmon. She’s the executive director of the Biosimilars Council and executive vice president of Policy and Strategic Alliances for the Association for Accessible Medicines in Washington, D.C.
Another big cost factor is the lack of competition in America’s biologic marketplace. Making the “generic” version of a biologic (called a biosimilar medication) is costly and involves a rigorous approval process. That discourages some drugmakers from getting into the biosimilar business.
“Biosimilar development can require 8 to 10 years, at a cost of $100 million to $250 million. This is significantly greater than the cost to develop traditional generics,” Simmon says.
How to save money on biologics
Despite the high cost of biologics, there are ways to save money on these medications. Here’s how.
Swap in a biosimilar medication
Biosimilar medications are very close in function and structure to the biologic medications they mimic. They also have to prove to be just as safe and effective.
There are 33 biosimilar medications approved by the FDA with dozens more in the pipeline, Simmon says. The hope is that as more biosimilar medications become available, the cost of both biologics and biosimilars will go down.
Biosimilars are usually 15% to 35% cheaper than their biologic counterparts. Examples of biosimilars include:
- Mvasi and Zirabev (biosimilars for Avastin). Avastin is a biologic that treats several types of cancer. This includes lung, brain, cervical, kidney and colorectal cancers. Mvasi was the first biosimilar medication approved to treat cancer, followed by Zirabev.
- Zarxio and Nivestym (biosimilars for Neupogen). Neupogen is one of the oldest biologics. Its biosimilar, Zarxio, was the first biosimilar approved by the FDA, in 2015. Zarxio and Nivestym, like Neupogen, stimulate white blood cell production. This helps people undergoing cancer treatment be less susceptible to infections.
- Semglee (interchangeable biosimilar for Lantus) and Cyltezo (interchangeable biosimilar for Humira). The term “interchangeable” is key here. This means that in some states, your pharmacist can swap in a biosimilar for its brand-name biologic without needing a doctor to change the prescription. For example, if a doctor wrote a prescription for the long-acting insulin Lantus, a pharmacist could fill the prescription with the less expensive Semglee. It’s still a good idea to make sure your doctor is fine with the switch.
Talk to your doctor about your medication options. In many cases, if you do decide to switch to a biosimilar, they’ll need to give you a new prescription.
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Go through insurance
The good news: Many insurance plans cover biologics. The not-so-good news: You might have to jump through hoops to get them covered.
Many insurance companies require a medication to be approved before they agree to pay for a biologic. This is called prior authorization. There can also be the very specific risk evaluation and mitigation strategy (REMS) that the FDA requires for some of these medications to make sure the benefits outweigh any risks.
“REMS can require certain monitoring or laboratory evaluation prior to starting therapy. It could require strict education for patients and prescribers. All of these need to be met before the drug can be dispensed. The insurance carriers will require this to be done before approving the biologic,” Kier says.
You might also have to take a biologic or different medication first before you’re allowed to take a biosimilar that your insurance would pay for. Still, it’s well worth checking to see what your insurance will cover.
Look for assistance plans and discounts
Many companies that make biologics offer discounts and savings to people who can’t afford their product. That might include covering copayments or providing discounted (or even free) medication. You may also be eligible for a free trial or other offers that aren’t necessarily based on income or insurance.
Visit the manufacturer’s website for the medication to find out what offers are available. You can also search for aid by medication name on Medicare’s site. Medicare also allows you to search for a State Pharmaceutical Assistance Program.
You want to make sure you’re getting the best treatment possible for your condition. If cost is holding you back, don’t be afraid to talk with your doctor or pharmacist. They can help you weigh the pros and cons and find a solution that works for you.
Try Optum Perks to save on your other medications
It can be tough to find savings on biologics on prescription discount sites because these medications have little competition. But you could save on other medications you may be taking.
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Cost of biologic medication: Drugs (2018). “Why biologics and biosimilars remain so expensive: Despite two wins for biosimilars, the Supreme Court’s recent ruling does not solve fundamental barriers to competition”
Background on biologics and how they’re made: U.S. Food and Drug Administration